Provider Demographics
NPI:1962039339
Name:RONDEAU, JESSICA (HIS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:RONDEAU
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 N BAGLEY ST
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-8215
Mailing Address - Country:US
Mailing Address - Phone:989-354-4494
Mailing Address - Fax:
Practice Address - Street 1:1033 N BAGLEY ST
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-8215
Practice Address - Country:US
Practice Address - Phone:989-354-4494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501008948237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist